Factors Associated With an Interest in Practice-Based Research Among Pharmacists in Nigeria

Abstract

Background: Practice-based research (PBR) is employed in the pharmacy profession to improve the quality and efficiency of health care delivery. Although widely practiced in developed countries, it is rarely used in developing countries, including Nigeria. Objectives: To determine the factors associated with Nigerian pharmacists’ interest in PBR. Methods: This is a cross-sectional study utilizing an online survey. Pharmacists currently practicing in Nigeria were invited to participate. A hyperlink to the online questionnaire was shared with members of relevant professional bodies via Facebook, WhatsApp, and Twitter. Reminders were sent to facilitate a high response rate. Factors associated with pharmacists’ interest in PBR were determined using multiple logistic regression. Results: Two hundred and three completed responses were received from the survey. The majority, 94.6% (192), expressed an interest in PBR and believed that it would enhance their pharmacy practice and role in patient care. The multivariable analysis showed that pharmacists’ interest in publishing their research findings in peer-reviewed journals (odds ratio = 0.004, 95% confidence interval = 0.00-0.05, P < .001) and their knowledge of the professional relevance of research pertaining to their area of practice within the health care system (odds ratio = 0.02, 95% confidence interval = 0.00-0.47, P = .015) were found to be independent predictors of pharmacists’ interest in PBR. Conclusion: There is an interest in PBR among practicing pharmacists in Nigeria. The provision of evidence-based pharmaceutical services in Nigeria will be enhanced by interventions that encourage the conduct of research and publication of research findings, and by improving knowledge of the professional relevance of PBR in pharmacy practice areas.

Introduction

A practice-based research network is a group of practices primarily devoted to improving the quality and delivery of patient care by developing policies for continuous quality improvement.¹ Practitioners work with researchers and administrators to develop tools that facilitate relevant data collection and analysis.¹ This subsequently supports the development of new protocols and policies aimed at improving pharmacists’ service delivery.

Pharmacy practice research is a component of health services research that focuses on the assessment and evaluation of pharmacy-related practices.¹ Such research can inform evidence-based practice. This is essential for the effective delivery of pharmaceutical care and to broaden the scope of pharmacy practice.² In recent decades, medicine has overshadowed pharmacy in practice-based research (PBR) participation,³ although, pharmacists’ involvement in PBR appears to be increasing. This increased pharmacist participation has supported an expanded role for pharmacists in the provision of patient-centered care that optimizes health outcomes.^4,5 The ongoing advocacy and support of PBR by professional pharmacy bodies worldwide should encourage pharmacists to better engage in research that informs the continuous improvement of pharmacy practice.

Pharmacists are responsible for providing patient education, counseling, and medication management and for supporting the prevention of disease/drug-related complications.^6,7 To optimize these roles, pharmacists should acquire the knowledge and skills required to meet the needs of their patients and their professional role within the health system. They must be able to identify, critically appraise, and effectively utilize the best available information and evidence in order to make informed clinical decisions and develop evidence-based policies. Pharmacists should have the capacity to generate and disseminate knowledge through research and publications, and these endeavors can subsequently advance pharmacy practice, improve patient outcomes, and enhance the efficiency of health care delivery.^6,8 Although evidence suggests that pharmacists recognize the value of PBR, and its potential to improve pharmacy practice, most hospital- and community-based pharmacists are not engaged in research.^3,8-10

Although the involvement of pharmacists in PBR has increased in recent years, there is a paucity of evidence pertaining to pharmacy practice in Asia, the Middle East, and Africa, with most research published to date originating from Western countries. In order to address the lower rates of PBR in the aforementioned regions, any obstacles to pharmacist participation should be addressed. A Qatari study found that although the majority of participants were keen to participate in PBR, their environment and individual personality traits could act as barriers to such endeavors.¹¹ These findings align with the social cognitive theory that states that an individual researcher is influenced by both their environment and personality.¹² These factors could help or hinder the implementation of PBR. The environmental factors that may influence PBR participation include financial incentives, support from authority, peer group motivation, and the presence of a research culture within the individual’s workplace. Personal attributes associated with PBR involvement include personal interest and satisfaction derived from participation, being open to new ideas, and a desire to provide improved quality of care to patients. Both environmental factors and personality affect an individual’s interest in research.¹³

Patient-oriented pharmacy practice research, particularly in community and hospital settings, is required in order to facilitate continuous improvement in pharmacy practice across the continuum of care. Such research is scarce in developing countries, including Nigeria. The aim of this study was, therefore, to determine the factors associated with Nigerian pharmacists’ interest in PBR. A supplementary aim was to identify specific areas of focus for future PBR research in Nigeria.

Materials and Methods

Study Design and Population

A cross-sectional study design in the form of an online survey was employed for pharmacists currently practicing in Nigeria. The survey was conducted over a period of 30 days between April and May 2018. Pharmacists were eligible to participate in the study if they were fully registered and licensed with the Pharmacists Council of Nigeria, currently practicing as a pharmacist in Nigeria, and had an active social media account (WhatsApp, Facebook, or Twitter) registered in their name. Intern pharmacists with provisional registration to practice as pharmacists in Nigeria were excluded. Purposive sampling was used in the selection of social media groups to represent samples from the 6 geopolitical zones in Nigeria.

Data Collection and Development of Data Collection Tool

The questionnaire was modified from Fakeye et al.¹⁴ The face validity of the questionnaire was determined by an expert panel composed of 6 pharmacists who represented the range of areas of pharmacy practice in Nigeria. The questionnaire was pilot tested by potential participants. The items in the questionnaire that appeared to be ambiguous were reworded based on the feedback received from the expert panel and the pilot test. The close-ended questionnaire was designed using “Google Form” to facilitate web-based administration. The introduction section of the survey form outlined the objectives of the study, the eligibility criteria, and the consent statement. Section A collected the socio-demographic information including age, gender, years of experience, qualification, and area of pharmacy practice. Section B contained 13 items related to the assessment of the pharmacist’s involvement in research.

Data Collection

The hyperlink to the Google Form (the questionnaire) was shared with the potential participants via the social media groups (WhatsApp, Facebook, and Twitter) of practicing pharmacists in Nigeria. Participation was voluntary and consent to participate in the study was implied by completing the survey. This online study was not affiliated with any institution. Permission to share the online survey form was sought up from the administrator of the social media group or the chairman of the relevant pharmacy association.

Sample Size Estimation

Based on an expected proportion (p) of 90% of pharmacists expressing an interest in PBR, as per the findings from a previous study,¹⁴ precision of 0.05 (Δ), and a z value of 1.96, a sample size of 138 was calculated using single proportion formula. To address nonresponses or missing values, the calculated sample size was increased by 30%. Therefore, the minimum respondents estimated in the current study was 179.

Data Analysis

The collected data were exported to Microsoft Excel from the Google Form. The data were then exported to IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp, Armonk, NY) and then cleaned and analyzed. The numerical variables were presented as mean and standard deviation, while the categorical variables were summarized as frequencies and percentages. The factors associated with interest in PBR were determined using multiple logistic regression (MLR). Univariable analysis was conducted using simple binary logistic regression to screen each variable for multivariable analysis.

From the results of simple logistic regression, variables that had a P < .25 and those considered clinically relevant were included in the MLR. P < .25 was considered as a rule of thumb to ensure that variables potentially associated with pharmacists’ interest in PBR were not excluded from the multivariate analysis. Multivariable analysis was subsequently conducted to determine the factors independently associated with PBR. The results of the simple logistic regression were presented as a crude odds ratio (OR) with 95% confidence intervals (CIs) and corresponding P values. Multivariable analysis was performed using the backward likelihood ratio option to determine the adjusted OR of the potential independent risk factors. Multicollinearity and interactions between the variables were checked. Assumptions were checked using Hosmer-Lemeshow, the classification table, and the receiver operation curve. The final model was presented as adjusted ORs with 95% CIs and corresponding P values.

Results

A total of 203 completed responses were received despite sending out reminders 2 weeks after commencement of the survey. More than 50% of the respondents were male, with the highest proportion aged between 30 and 39 years (49.3%). Approximately 50% of respondents practice as hospital pharmacists followed by community pharmacists (24.1%). A lower proportion of respondents were from academia, administrative, and nongovernmental organizations. Most of the pharmacists had 5 years or less experience in their practice area (59.1%). A higher proportion had additional postgraduate academic qualifications. Table 1 summarizes the characteristics of the respondents.

Table 1.

Demography and Characteristics of Pharmacists Respondents (N = 203).

Variable	Frequency, n (%)
Gender
Female	69 (34)
Male	134 (66)
Age (years)
20-29	79 (38.9)
30-39	100 (49.3)
40-49	16 (7.9)
>50	8 (3.9)
Years of experience
<5 years	120 (59.1)
≥5 years	83 (40.9)
Additional qualification
PhD	10 (4.9)
MSc	57 (28.1)
WAPCP	78 (38.4)
Other	58 (28.6)
WAPCP
Fellow	17 (8.4)
Not enrolled	149 (73.4)
Student	37 (18.2)
Interest in research
No	11 (5.4)
Yes	192 (94.6)

Abbreviations: PhD, doctor of philosophy; MSc, master of science; WAPCP, West African Postgraduate College of Pharmacist.

Pharmacist Interest in PBR

Table 2 illustrates the respondents’ interest in PBR. A total of 192 (94.6%) reported having an interest in PBR within their area of practice. Only 5.4% showed no interest in PBR. The majority of participants believed PBR is relevant and part of their professional duty. Additionally, the respondents believed they have the skills to conduct PBR research. However, more than half of the participating pharmacists indicated that research is challenging to conduct. Of the total respondents, 114 (56.2%) reported that they do not have time to conduct research, while 155 (76.4%) possessed the skills and 179 (88.2%) had the confidence to conduct research.

Table 2.

Pharmacists Interest in Practice-Based Research.

Variable	Frequency (%)
Interest in publication
No	16 (7.9)
Yes	187 (92.1)
Practice area
Hospital	99 (48.8)
Community	49 (24.1)
Academia	23 (11.3)
Administrative	9 (4.4)
Industrial	9 (4.4)
Nongovernmental organization	5 (2.5)
Others	9 (4.4)
Research as a professional duty
No	10 (4.9)
Yes	193 (95.1)
Time to conduct research
No	114 (56.2)
Yes	89 (43.8)
Skills to conduct research
No	48 (23.6)
Yes	155 (76.4)
Confidence to conduct research
No	24 (11.8)
Yes	179 (88.2)
Past training in research
No	59 (29.1)
Yes	144 (70.9)
Research is suited to academia
No	139 (68.5)
Yes	64(31.5)
Relevance to your practice area
No	6 (3.0)
Yes	197 (97)
Presence of research opportunity in your area of practice
No	82 (40.4
Yes	121 (59.6)
Challenge in accessing research materials and funding
No	14 (6.9)
Yes	189 (93.1)
Research is of little importance to pharmacy practice
No	178 (87.7)
Yes	25 (12.3)
The research will improve your practice area
No	1 (0.5)
Yes	202 (99.5)
Research is difficult to conduct
No	94 (46.3)
Yes	109 (53.7)

Factors Associated With Pharmacists’ Interest in PBR

Table 3 shows the results of the univariable analysis. Of the 12 variables analyzed, 7 were selected for the MLR. Five variables had a P > .25 and were excluded. The results of the final MLR model are presented in Table 4. Pharmacists’ interest in conducting and publishing research (OR = 0.004, 95% CI = 0.00-0.05) and pharmacists’ knowledge of how research is relevant to their area of practice (OR = 0.02, 95% CI = 0.00-0.47) were the 2 factors found to be independent predictors of Nigerian pharmacists’ interest in PBR.

Table 3.

Simple Logistic Regression: Associated Factors With Interest in Research among Pharmacists in Nigeria.

Variable	Regression Coefficient (b)	Crude Odds Ratio (95% CI)	Wald Statistics	P
Interest in publication
No	0	1
Yes	4.78	118.92 (21.55-656.21)	30.07	<.001
Research as a professional duty
No	0	1	3.59	.058
Yes	1.631	5.11 (0.95-27.64)
Time to conduct research
No	0	1
Yes	0.33	1.39 (0.39-4.9)	0.26	.690
Skills to conduct research
No	0	1
Yes	−0.35	0.71 (0.15-3.38)	0.19	.662
Confidence to conduct research
No	0	1
Yes	−0.31	0.74 (0.09-0.60)	0.08	.004
Past training in research
No	0	1
Yes	0.76	2.13 (0.62-7.27)	1.46	.228
Research is suited to academia
No	0	1	2.66	.103
Yes	−1.02	0.36 (0.11-1.23)
Relevance to your practice area
No	0	1	12.55	<.001
Yes	3.16	23.63 (4.11-135.91)
Presence of research opportunity in your area of practice
No	0	1	0.94	.332
Yes	0.61	1.83 (054-6.21)
Challenge in accessing research materials and funding
No	0	1	2.66	.15
Yes	1.82	6.17 (0.11-1.23)
Research is of little importance in pharmacy practice
No	0	1	0.11	.739
Yes	0.36	1.43 (0.18-11.67)
Research is difficult to conduct
No	0	1	3.19	.074
Yes	−1.42	0.24 (0.51-1.15)

Abbreviation: CI, confidence interval.

Table 4.

Multiple Logistic Regression: Final Model^a.

Variables	Adjusted ORb (95% CI)	Wald Statisticb (df)	P c
Interest in research publication
No	1.00
Yes	0.004 (0.00-0.05)	18.52 (1)	<.001
Pharmacists knowledge on the relevance of research in the area of practice
No	1
Yes	0.02 (0.00-0.47)	5.89 (1)	.015

Abbreviations: OR, odds ratio; CI, confidence interval; df, degrees of freedom.

^aMulticollinearity and interaction terms were checked and not found, Hosmer-Lemeshow test (P = 1.000) and classification table (overall correctly classified percentage = 98.0%), as well as area under the receiver operating characteristic curve = 99.5%, was applied to check the model fitness, and reported to be fit.

^bOR, CI, forward likelihood ratio option were applied.

The predictive power of the model was found to be good (area under the receiver operating characteristic curve = 99.5%, 95% CI = 0.98-1.00, P < .001), which indicates the model is appropriate for discriminating pharmacists’ interest in PBR in Nigeria. No possible collinearity in the included variables was observed. Interactions between variables were also assessed, and none were identified. The model fit for the data was excellent; Hosmer-Lemeshow test was significant (P = 1.00).

Discussion

The current study is among the first in Nigeria to identify the factors associated with pharmacists’ interest in conducting PBR. The study was an online survey, so it was difficult to determine the response rate since the number of eligible participants who received the survey link is unknown, hence the use of completion rate. However, the number of respondents was 203, which was higher than the calculated sample size (179). The majority of the respondents showed an interest and positive attitude toward PBR. This finding is inconsistent with studies conducted among community pharmacists in the United Kingdom, Ethiopia, and Qatar.^15-17 In our study, we included pharmacists from all areas of pharmacy practice in Nigeria, including hospitals, community settings, and academia. The majority of respondents have additional postgraduate qualifications and more than 5 years of practice experience. These factors could explain the increased interest in PBR observed in our study. Based on self-assessment, the majority of respondents reported having the confidence and skills to conduct research (>80% and >70%, respectively). These findings indicate the likely acceptance and potential success of an intervention to implement PBR at pharmacy practice areas in Nigeria.

The respondents were mostly based in hospital and community practice settings. This is consistent with findings of a similar study conducted among hospital and community pharmacies in Nigeria.¹⁴ In our study, the participants reported having the skills and confidence to conduct PBR. However, inadequate time was stated as a barrier for conducting PBR. A previous study reported limited time required to conduct research by pharmacists as an obstacle to successful PBR.¹⁰ In the current study, almost half of the pharmacists felt research is challenging to perform. Moreover, many of the pharmacists reported access to research materials and funding as a challenge to PBR. These challenges may be related to the inadequate funding, availability of research facilities, and political support of research by government officials in Nigeria.¹⁸ Similarly, inadequate funding has been previously reported as a challenge among medical and health care researchers.¹⁹

Based on the results of the final model of the MLR, 2 factors were associated with interest in PBR among pharmacists in Nigeria: interest in the conduct and publication of research and knowledge of how the research was relevant to their area of practice. Our study found that there is 99.6% lesser chance of having interest in PBR for a pharmacist who has no interest in research publications. This indicates that a lack of interest in publication may be reflected in poor support for PBR. However, barriers to improving pharmacists’ interest in research publications are multifactorial.²⁰ Ajao and Ugwu highlighted some factors responsible for the low publication rate of medical researchers in Nigeria.²⁰ The factors include the lack of finance and skills, the problem of journal indexing, and the quality of the research conducted. PBR can thus be improved by increasing awareness on research publication, motivating, training, and supporting the pharmacists in the skills necessary to publish research in a peer-reviewed journal. These factors may have explained the weak interest in publication among the participants in the current study. In order to improve the research output of pharmacists in Nigeria, pharmacists practicing in academia, with greater knowledge of research, and greater access to research funding should be encouraged to better collaborate with pharmacists in other areas of practice who may need support to conduct and publish research. A collaborative effort between academicians and other pharmacists practicing in hospital or community settings have shown to improve PBR.²¹ Courses focusing on how to conduct research and preparing an article for publication in a peer-reviewed journal can also be co-opted in the Mandatory Continuing Professional Development of the PCN.

We found a 98% lesser chance of having interest in PBR among practicing pharmacists without knowledge of how such research is relevant to their work. This is similar to a study conducted in Sydney, Australia, by Kritikos et al.²² In our study, approximately 75% of the pharmacists practice in hospital and community pharmacies. In Nigeria, it is not a professional requirement for pharmacists to undertake research. This makes research less relevant to the role of hospital- and community-based pharmacists when compared with those working in academia. Furthermore, the inadequacy or absence of evidence-based practice in Nigeria may affect pharmacists’ interest in research.²³ Community and hospital pharmacies are appropriate avenues to conduct and implement research findings to improve patient care. In this area of pharmacy practice, the pharmacists are always in contact with patients/consumers, collecting clinically relevant data that could be used for research purposes. Findings from such research have the potential to support evidence-based practice and improve pharmaceutical services. Increased awareness by pharmacists on the importance of research in these practice areas could help boost PBR.

Research is an essential endeavor for every area of pharmacy practice in Nigeria. Research plays a crucial role in identifying, investigating, and improving patient safety. Therefore, implementation of research training, information, and ease of access to facilities for research in other areas of pharmacy practice, particularly hospitals and community pharmacies, will be of great importance to improve the interest in research for policy changes and implementation in Nigeria. Importantly, factors such as the interest of pharmacists in research publications need to be taken into consideration. This can be done through organizing seminars, workshops, and colloquiums to highlight the benefits of research publication to the developments of their fields. In addition, incentives given to pharmacists who publish can motivate and encourage pharmacists to submit articles for publication. The relevance of research to the pharmacist’s area of practice needs to be highlighted.

The current study is not without some limitations. First, the online nature of the survey may have automatically excluded pharmacists who do not use online social media platforms. As such, the generalizability of our findings may have been affected. Second, the higher proportion of younger pharmacists in this study may not reflect the true demographic profile of the pharmacy profession in Nigeria. Last, the calculated sample size may have been too small to generate statistically significant findings. This may be related to the higher value of the expected proportions in survey responses found in the previous study and on which our sample size determination was based. These may limit the generalizability of our findings. Future studies with adequate funding support may be conducted with a larger sample size to better facilitate the generalization of research findings.

Conclusion

There is an interest in PBR among practicing pharmacists in Nigeria. Interventions to encourage research publication and to improve pharmacists’ knowledge and awareness of the relevance of PBR to practice areas will enhance the provision of evidence-based pharmaceutical practice in Nigeria.